title: Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel.
abstract: OBJECTIVE
  To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients.
  
  
  METHODS
  A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUV(max) percentage changes (ΔSUV(max)) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUV(max) could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD).
  
  
  RESULTS
  pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD.
  
  
  CONCLUSIONS
  Accuracy of ΔSUV(max) in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery.
authors.affiliation: Nuclear Medicine Department, Hospital Clínico San Carlos, Madrid, Spain; Radiology Department, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: marta.garcia@gmx.de.
authors.forename: Marta A
authors.initials: MA
authors.lastname: García García-Esquinas
authors.affiliation: Radiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Arrazola García
authors.affiliation: Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: García-Sáenz
authors.affiliation: Pathology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Furió-Bacete
authors.affiliation: Research Support Unit, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Fuentes Ferrer
authors.affiliation: Nuclear Medicine Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Aída
authors.initials: A
authors.lastname: Ortega Candil
authors.affiliation: Nuclear Medicine Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: María N
authors.initials: MN
authors.lastname: Cabrera Martín
authors.affiliation: Nuclear Medicine Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Carreras Delgado
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy; D000077143:Docetaxel; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008408:Mastectomy; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D043823:Taxoids / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D000068878:Trastuzumab; D047368:Tumor Burden
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D019275:Radiopharmaceuticals; D043823:Taxoids; D019788:Fluorodeoxyglucose F18; D000077143:Docetaxel; D000068878:Trastuzumab
keywords: Breast cancer; Cáncer de mama; Neoadjuvant chemotherapy; PET-CT; PET-TC; Quimioterapia neoadyuvante